GUIDELINES FOR Consent to Participate in ApprovedResearch Form
FormCFG05092017
The following are guidelines to creating the consent form to be signed
by all participants in approved research.
Dissertation Title: Place dissertation title here Name of
Participant: Type in the name of the participant here, along with
contact
information. Name of Mentor: Place your faculty advisor’s name and
contact information here.
Description:
Include a description of the research you intend to perform, and the
purpose of the research. This description should contain enough detail
that your subjects can make an intelligent, informed decision about their
participation in your project. Identify any procedures which are
experimental.
Time Commitment
Each subject should be provided with a general expectation of the
duration of the subject’s participation for completing the research
Payment
If subjects are to receive compensation for their time and effort, that
should also be explicitly stated. If compensation is to be provided, a
record of receipt signed by both parties.
Risks
Every situation may come with risks. Include a description of any
reasonably foreseeable risks or discomforts to the subject. If these risks
can be considered minimal, include the following statement: “I do not
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anticipate any risk to you participating in this study other than those
encountered in day to day life.”
Benefits
Include a description of any benefits to the subject or to others which
may reasonably be expected from the research.
Disclosure
Include a disclosure of appropriate alternative procedures or courses of
treatment, if any, that might be advantageous to the subject
Special Populations:
If your project requires the use of minors or other special populations,
then implied consent MAY NOT be used. Any research involving minors
must have informed consent addressed to the parent or guardian and
include a signature line for them.
Confidentiality:
Any information that is obtained in connection with this study and that
can be identified with you will remain confidential and will be disclosed
only with your permission or as required by law. Describe coding
procedures and plans to safeguard data if subject identities will be kept
confidential. (If participants will remain anonymous, then reword the
above to reflect that and state how the information will be kept
anonymous.) State any additional entities to whom the information will
be released, the nature of the information, and the purpose of the
disclosure.
Questions and Contact Information
Explain whom to contact for answers to pertinent questions about the
research and research subjects’ rights, and whom to contact in the event
of any negative effects or research-related injury to the subject.
Right to Withdraw
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No one should ever feel obligated to participate or continue
participation in a project with which they are uncomfortable. A right to
withdraw statement would include the following: “Your participation is
voluntary, refusal to participate will involve no penalty or loss of
benefits to which you are otherwise entitled and you may discontinue
participation at any time without penalty or loss of benefits to which you
are otherwise entitled.”
Dissertation Mentor Committee Approval:
You should include the following information so that the participant
knows that the study has met the ethical standards and requirements of
IQUIM: “This research proposal has been reviewed and approved by
The Dissertation Mentor Committee and it has been determined that this
study meets the ethical obligations required by University policies.
Participant Signature
Ask the participant to sign and date this agreement:
“My signature below formally acknowledges that I have read this
document and understand the information contained herein. My
questions and concerns have been answered by the researcher.”
Participant Signature: Date:
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Formatting
Title Page
Citation
Outline
